tbuckley/cabot-search huggingface dataset:
Abstract 9925: Patient-Reported Treatment Satisfaction in Etripamil-Mediated Conversion of Supraventricular Tachycardia to Sinus Rhythm: Results From the NODE-301 Study
Authors: James E Ip, Bruce S Stambler, Francis Plat, Benoit Coutu, Blandine Mondesert, Atul Verma, Silvia Shardonofsky, Alan J Camm
Journal: Circulation (2022)

Introduction: Etripamil is a fast-acting, intranasally administered non-dihydropyridine, L-type calcium channel blocker in development for medically unsupervised self-administration to treat AV nodal-dependent paroxysmal supraventricular tachycardia (PSVT). The objective of this analysis was to compare patient-reported effectiveness and relief of symptoms for patients whose PSVT terminated (converters) versus non-converters within 10 and 30 minutes of etripamil treatment. Methods: NODE-301 (NCT03464019) is a randomized, double-blind, placebo-controlled phase 3 study. Patients self-administered the study drug (etripamil 70 mg) or placebo intranasally in response to a perceived SVT episode and were then monitored for 5 hours. Perceived treatment effectiveness was assessed via the Treatment Satisfaction Questionnaire for Medication 9 (TSQM-9) effectiveness domain and patient-reported relief of symptoms was assessed by item 2. Converters and nonconverters were compared via 2-way ANOVA. Results: Of 107 patients who self-administered etripamil in response to a positively adjudicated SVT episode, 34 (32%) converted to sinus rhythm within 10 minutes, and 56 (54%) converted within 30 minutes. For both time points, converters had significantly higher mean TSQM domain scores for drug effectiveness and symptom relief compared with nonconverters ( Table ; P &lt;0.001). Conclusion: Patients with PSVT who self-administered etripamil in response to an SVT episode reported higher effectiveness and better symptom relief when their episode was resolved within the first 10 and 30 minutes of the 5-hour monitoring period.
Abstract 9893: The Associations Between Layer-Specific Global Circumferential Strain Parameters and Incident Heart Failure: The Copenhagen City Heart Study
Authors: Kristoffer G Skaarup, Mats H Lassen, Niklas D Johansen, Gorm B Jensen, Peter Schnohr, Rasmus Mogelvang, Tor Biering-Srensen
Journal: Circulation (2022)

Introduction: Global circumferential strain (GCS) has been demonstrated to be sensitive marker of early cardiac pathology compared to conventional echocardiographic measurements. Improvement in speckle tracking echocardiography has introduced layer-specific quantification of GCS. This study investigated the differences in the prognostic value of endomyocardial (GCS Endo ) and epimyocardial (GCS Epi ) GCS regarding incident HF (heart failure) in the general population. Methods: The prospective cohort study included randomly invited individuals from the general population. All participants were examined with echocardiography. Exclusion criteria were prevalent HF at baseline, non-sinus rhythm during echocardiography and inadequate image quality for speckle tracking analysis. Cox proportional hazard regression models were utilized to assess associations between GCS Endo and GCS Epi with incident HF. A multivariable model was created, which included left ventricular (LV) ejection fraction, LV mass index, and the variables from the ARIC HF risk score. Results: A total of 2874 individuals were included in the study sample. Mean age was 53 years ± 18 years and 40% were males. Mean GCS Endo and GCS Epi were 31.9 ± 5.3% and 14.3 ± 4.0% respectively. During a follow-up period of 5.4 years (IQR: 4.5; 6.3) 52 suffered incident HF. The cumulative incidence of HF according to the medians of layer-specific GCS is illustrated in Figure 1. In multivariable Cox regressions, GCS Endo remained significantly associated with HF (HR = 1.06 95%CI: [1.00; 1.12], per 1 % decrease), while GCS Epi did not (HR = 1.01 95%CI: [0.94; 1.10], per 1 % decrease). The same pattern was observed when only adjusting for age and sex. Additionally, GCS Endo provided significantly higher Harrel’s C-statistics as compared to GCS Epi (0.68 95%CI[0.58; 0.77] vs 0.60 95%CI[0.50; 0.69]). Conclusions: In the general population, GCS Endo is independently associated with incident HF while GCS Epi is not.
Abstract 9961: Benefits of Successful Percutaneous Coronary Intervention in Chinese CTO Patients With Low LVEF
Authors: Shuai Zhao, Kun Lian, Chengxiang Li
Journal: Circulation (2022)

Introduction: Low left ventricular ejection fraction (LVEF) was commonly seen in chronic total occlusion (CTO) patients and was considered as an independent risk factor of poor prognosis of those patients. Yet, data regarding the clinical outcome, symptom and quality of life (QOL) of successful recanalization of CTO in low LVEF patients were scarcely reported. Objectives: This study set out to assess the clinical outcome, symptoms and QOL of CTO treated with percutaneous coronary intervention (CTO-PCI) in Chinese patients with low LVEF. Methods: Patients consecutively undergoing elective CTO-PCI were included and subdivided into 3 groups: LVEF≥50%, 50%&gt;LVEF≥40%, and LVEF&lt;40%. Detailed baseline characteristics, assessment of symptoms and QOL, procedural details, in-hospital complications, and 1 month and 1 year follow-up data were collected. Results: Of 995 CTO patients, LVEF&lt;40% was present in 172 (17.29%), who had more previous MI, multi-CTO lesion and higher SYNTAX score (p&lt;0.001), and their procedural success rate did not drop significantly compared with the other two groups (93.95% vs. 92.31% vs. 88.95%; p=0.078). In-hospital MACCE (2.55% vs. 2.56 vs. 8.14%; p=0.001) was the highest in patients with LVEF&lt;40%. At 1 month and 1 year follow-up, MACE and all-cause mortality were also the highest in patients with LVEF&lt;40% after successful CTO-PCI, while they were markedly lower than those with failed CTO-PCI (p&lt;0.001). LVEF&lt;40% was an independent risk factor of MACE and all-cause mortality 1 year after successful revascularization. Symptoms and QOL were markedly improved regardless of LVEF at 1 month and 1 year follow-up, notably at a similar degree between patients with LVEF&lt;40% and the other two groups (P&gt;0.05). Conclusions: PCI could represent an effective revascularization strategy improving clinical outcome, symptoms and QOL in CTO patients with low LVEF.
Abstract 9873: Erroneous Electrocardiographic Interpretations and Its Clinical Implications
Authors: Ayesha Shaik, Nirav Patel, Chikezie Alvarez, Gregory Panza, William Baker, Sean Mcmahon, Jeffrey Kluger
Journal: Circulation (2022)

Introduction: Advancement of artificial intelligence (AI) has aided clinicians in the interpretation of electrocardiograms (ECGs) serving as an essential tool to provide rapid triage and care. However, in some cases, AI can misinterpret an ECG and may mislead the interpreting physician. Therefore, we aimed to describe the rate of ECG misinterpretation and its potential clinical impact in patient's management Methods: We performed a retrospective descriptive analysis of misinterpreted ECGs and its clinical impact from May 28, 2020 to May 9, 2021. An electrophysiologist screened ECGs with confirmed diagnosis of atrial fibrillation (AF), sinus tachycardia (ST), sinus bradycardia (SB), intraventricular conduction delay (IVCD), and premature atrial contraction (PAC) that were performed in the emergency department. We then classified the misinterpreted ECGs as pseudo-AF, ST, SB, IVCD, or PAC into the correct diagnosis, and reviewed the misinterpreted ECGs and medical records to evaluate inappropriate use of antiarrhythmic drugs (AAD), beta-blockers (BB), calcium channel blockers (CCB), anticoagulation, or resource utilization of cardiology and/or electrophysiology (EP) consultation. Results: A total of 4,969 ECGs were screened with diagnoses of AF (2,282), IVCD (296), PAC (972), SB (895), and ST (638). Among these, 101 ECGs (2.02%) were misinterpreted. Pseudo-AF (58%) was the most common followed by pseudo-PAC (15%), pseudo-ST (13%), pseudo-IVCD (8%) and pseudo-SB (6%). Patients with misinterpreted ECGs were aged 76.6±11.6yr with male (52.5%) predominance and hypertension being the most prevalent (83.2%) comorbid condition. The misinterpretation of ECGs led to the inappropriate use of BB (19.8%), CCB (5.0%), AAD therapy (7.9%), anticoagulation (30.7%) in patients with pseudo-AF, as well as inappropriate resource utilization including cardiology (41.6%) and EP (8.9%) consultations. Conclusions: Misinterpretation of ECGs may lead to inappropriate medical therapies and increased resource utilization. Therefore, it is essential to encourage physicians to carefully examine AI interpreted ECG’s, especially those interpreted as having AF.
Abstract 9866: A Cardiac Scale Based Digital Intervention Showed Improved Performance versus Usual Care for Detecting Worsening Heart Failure Events
Authors: Daniel Yazdi, Corey Centen, Kivanc Ozonat, Sarah Smith, Kimberly Obert, Sara Kendziorski, Meg Horgan, Joann Sciandra, Karen Murphy, Vishal C Mehra
Journal: Circulation (2022)

Introduction: There is a need for non-invasive, remote solutions for detecting worsening heart failure (HF) events. The Bodyport Cardiac Scale is a physical platform with sensors that measure hemodynamic signals through the user’s feet, including electrocardiogram, ballistocardiogram, and impedance plethysmogram. Biomarkers extracted from these signals are used as inputs to the fluid alert algorithm to detect worsening HF events. Hypothesis: The Bodyport fluid alert algorithm is able to detect worsening HF events more accurately and earlier compared to traditional weight-based monitoring. Methods: In a real-world deployment at Geisinger Health System, 97 patients with a history of HF and enrolled in remote care management were provided with a cardiac scale and monitored for 90 days. The care team had access to weight and was blinded to other biomarkers. Weight-based alerts were generated if a subject gained more than 3 lbs in 1 day or 5 lbs in a week. The fluid alert algorithm incorporates parameters derived from the impedance plethysmogram, weight change, and pulse rate. Alerts were classified as true positive if a worsening HF event requiring IV diuresis occurred within 15 days of the alert. Results: Forty-eight participants (49.5%) were female and the average age was 74 years. Daily scale adherence was 86.2%. The cardiac scale detected 12 of 12 (100%) HF events compared to 8 of 12 (67%) using the weight-based rule, p = 0.008. The median time from alert to event increased from 5 to 9 days and the alert burden decreased from 26 to 15 alerts/100 patients/week with the fluid alert algorithm. The area under the receiver operating characteristic curve for the algorithm is 0.85. Conclusions: The fluid alert algorithm is able to detect worsening HF events more accurately, earlier, and with a reduced alert burden compared to traditional weight monitoring. The cardiac scale and fluid alert algorithm have the potential to significantly enhance the remote management of HF patients.
Abstract 9921: E-cigarette Use and Markers of Endothelial Function in Diverse Young Adults From New York City: The VapeScan Study
Authors: Enoch X Jiang, Dona N Sangapalaarachchi, Nancy J LoIacono, Vesna Ilievski, Diane Hawkins, Elizabeth Oelsner, Ana Navas-Acien, Daichi Shimbo
Journal: Circulation (2022)

Introduction: Compared to traditional tobacco use, the cardiovascular effects of e-cigarette use, or vaping, an increasing behavior especially among young adults, are poorly understood. The ongoing VapeScan Longitudinal Study aims to determine the effects of vaping on participants’ endothelial health and other subclinical markers. Hypothesis: We hypothesized that e-cigarette use (alone or in combination with smoking), compared to never using e-cigarettes or smoking products, is associated with an adverse profile in markers of endothelial health in a diverse cohort of healthy young adults. Methods: We recruited 132 participants, aged 18-49 and residing in the greater New York area, between May 2021 and May 2022. Participants who were pregnant, had a history of cardiovascular or respiratory disease, smoked but did not vape, or formerly vaped, were excluded. Endothelial health was assessed via endothelium-dependent vasodilation using an EndoPAT2000 machine. Reactive Hyperemia Index (RHI) and Framingham RHI (fRHI) values were computed from the results. Participants missing EndoPAT data (n=3) were excluded from analysis, leaving 129 participants (17 vaping/never smoking, 19 vaping/former smoking, 24 vaping/smoking (dual use), and 69 never vaping/never smoking). Results: Participants’ median age was 26 years and 61% were female. Participants classified as vaping/never smoking and dual users were younger than the other groups (Table). Median levels of RHI and fRHI were lowest for dual users, although the differences across the four groups were not statistically significant (one-way ANOVA p-value = 0.27 for RHI and 0.10 for fRHI). Participants’ vaping/smoking status was not associated with RHI or fRHI in linear regression models adjusted for age and sex. Conclusions: Preliminary findings from the VapeScan Study support that subclinical measures of endothelial function are a promising tool to help identify early effects of tobacco product use in young adults.
Abstract 9867: Does Pain at Hospital Discharge Predict Transition From Hospital to Home and 12-month Mortality Among Patients With Heart Failure?
Authors: Asa B Smith, Miyeon Jung, Susan J Pressler
Journal: Circulation (2022)

Introduction: Pain is present in 37%-68.9% of hospitalized patients with heart failure (HF), but little is known about how pain at discharge influences transition from hospital to home or 12-month mortality. The aims were to examine if pain at discharge predicts 1) return to home status and 2) 12-month mortality among hospitalized patients with HF. Methods: In this prospective study, data were obtained from a dataset of 1,475 patients with HF hospitalized at 3 tertiary-care hospitals from 2009-2017. Pain at discharge (yes/no) was obtained from medical records using ICD-9 or ICD-10 codes. Return to home status (yes/no) and all-cause 12-month mortality were obtained from medical records. Descriptive statistics, independent samples t-tests, and χ 2 were used to describe the sample. Logistic regression was computed to address the aims. Results: The sample was 59.5% women and 40.5% men. The mean age was 68.6 (SD 13.6) years. Race was 53.6% Black and 46.4% White. Of 1,475 patients, 239 (16.2%) had pain documented at discharge. Patients with pain documented at discharge were younger compared to patients without pain (p&lt;.001). One hundred sixty-five of 239 patients (69.0%) with pain and 831 of 1,236 patients (67.2%) without pain returned to home (χ 2 =0.297, p=.585). At 12 months after discharge, 20 of 239 patients (8.4%) with pain had died compared to 134 of 1,236 patients (10.8%) without pain (χ 2 =1.31, p=.252). In logistic regressions, pain at hospital discharge was not a statistically significant predictor of return to home status or 12-month mortality (Table 1). Conclusions: Over 30% of patients with HF did not return to home after hospitalization. Patients with HF have significant transitional care needs, including pain management. Future studies are needed to determine the phenotypes of pain among patients with HF, evaluate associations between pain at discharge and transitional care needs, and design innovative strategies to ameliorate pain.
Abstract 9936: In-Hospital Management and Outcomes of Patients With and Without Prior Coronary Artery Bypass Graft Surgery Who Present With a Non-ST-Segment Elevation Myocardial Infarction
Authors: Nehal Dhaduk, Yuhe Xia, Carlos Alviar, Frederick Feit, Norma M Keller, Sripal Bangalore
Journal: Circulation (2022)

Introduction: The clinical course of patients with prior CABG presenting with non-ST elevation myocardial infarction (NSTEMI) is not well defined. We aim to compare the management and outcomes of patients with and without prior CABG who present with an NSTEMI. Methods: Patients hospitalized with an NSTEMI between 2002-2018 were identified from the National Inpatient Sample (NIS). Baseline characteristics and outcomes of patients with prior CABG were compared to patients without. Outcomes included the rates of invasive management (defined as coronary angiography, PCI or CABG), and its individual components, as well as mortality, length of stay, and in-hospital charges. Results: A total of 1,445,545 cases of NSTEMI were identified of which 133,691 (9.3%) had a prior CABG. Patients with prior CABG were older (72.4 vs 68.6 years, p &lt;0.001), more likely to be men (68.8% vs 56.9%, p &lt;0.001), and of white race (79.7% vs 74.8%, p &lt;0.001). The prior CABG cohort had lower rates of invasive management (50.4% vs 65.6%, p &lt;0.001), PCI (23.7% vs 32.0%, p &lt;0.001), or CABG (1.2% vs. 10.6%; p&lt;0.001) in the unmatched analysis. Results were consistent in the propensity score matching analysis with the prior CABG group less likely to receive any invasive intervention (OR: 0.48, 95% CI 0.47 - 0.49) including PCI (OR: 0.66, 95% CI 0.64 - 0.67) or CABG (OR: 0.11, 95% CI 0.10 - 0.12) when compared to the no prior CABG group (Figure 1). Moreover, the risk of in-hospital mortality was higher in the prior CABG group (OR:1.15, 95% CI 1.10 - 1.21). Conclusions: Patients with prior CABG who present with NSTEMI have lower rates of invasive management and revascularization with associated higher in-hospital mortality when compared with patients without prior CABG.
Abstract 9916: Prognostic Value of Simultaneous Analysis With Myocardial Flow Reserve and Right Ventricular Strain by Hybrid <sup>13</sup> N-ammonia Positron Emission Tomography/Magnetic Resonance Imaging in Coronary Artery Disease
Authors: Keiichiro Endo, Takatoyo Kiko, Ryo Yamakuni, Tomofumi Misaka, Takayoshi Yamaki, Kazuhiko Nakazato, Kenji Fukushima, Yasuchika Takeishi
Journal: Circulation (2022)

Introduction: Myocardial flow reserve (MFR) derived from 13 N-ammonia positron emission tomography (PET) is used to predict adverse cardiac events in the patients with coronary artery disease (CAD). Right ventricular (RV) strain measured by magnetic resonance imaging (MRI) is used to evaluate RV function. This study aimed to evaluate the prognostic value of combined MFR and RV strain measured by hybrid 13 N-ammonia PET/MRI in patients with CAD. Methods: Sixty-one patients who underwent 13 N-ammonia PET/MRI were enrolled. MFR was calculated from dynamic acquisition of 13 N-ammonia PET under vasodilator stress with intravenous injection of adenosine. RV global longitudinal strain (GLS) was measured by wall motion tracking techniques in cine-mode MRI. The end points were defined as a composite of all-cause death, myocardial infarction, sustained ventricular arrhythmia, hospitalization due to decompensated heart failure, and revascularization. Results: At a follow-up of 2.8 ± 1.9 years, 21 events occurred. Kaplan-Meier analysis showed that the event-free rate was significantly lower in the group with MFR &lt; 1.80 than that with MFR ≥ 1.80 (P &lt; 0.001, Figure a). Additionally, the event-free rate was significantly lower in the group with RVGLS &gt; –18.22% than that with RVGLS ≤ –18.22% (P = 0.025, Figure b). After dividing the patients into four groups by the median MFR and the median RVGLS, the event-free rate was lowest in the combined group of MFR &lt; 1.80 and RVGLS &gt; -18.22% than any other groups (P &lt; 0.001, Figure c). In the Cox proportional hazard analysis, MFR and RVGLS were independent predictors of cardiac adverse events in the patients with CAD. Conclusion: The simultaneous assessment of MFR and RV strain by 13 N-ammonia PET/MRI revealed the feasibility of precise risk stratification for cardiac events in patients with CAD.
Abstract 9995: Anemia is Associated With Increased Mortality and Adverse In-Hospital Outcomes in Women With Peripartum Cardiomyopathy: A Nationwide Data Analysis
Authors: Moiz Ehtesham, Arshan Khan, Al-Ameen Oredegbe, Maria Riasat, Muhammad Asim Shabbir
Journal: Circulation (2022)

Objective: Anemia is a common comorbidity during pregnancy and in non-pregnant females of childbearing age. Our goal was to ascertain its association with in-hospital mortality and complications in females with peripartum cardiomyopathy (PPCM). Methods: The national inpatient sample was retrospectively queried from 2011-2017 to identify all women aged 17 to 51 years with the diagnosis of PPCM. We further identified diagnosis of anemia within each admission using ICD-10 codes (D64.9 and D64.89). Primary outcome was inpatient mortality rate while secondary outcomes were in-hospital complications such as acute kidney injury (AKI), pulmonary edema and antepartum hemorrhage. Demographic (age, sex, race) and clinical (history of hypertension, stroke, myocardial infarction, obesity, smoking) data was also noted. Analysis was conducted using STATA 16.0. Adjusted odds ratios (AOR) were calculated with multivariate logistic regression method reported with confidence interval (CI) and a P-value (significance &lt;=0.05). Results: We recorded 211,476 hospitalizations for PPCM, out of which 38% (80,361) had anemia. Average age of the patients was 35 years and 78% of the women were Caucasian. Overall inpatient mortality rate was 3.9% and was higher in PPCM hospitalizations with anemia compared to those without anemia&amp;nbsp;[4.1% vs 3.3%; AOR: 1.24 (1.19 – 1.30, p&lt;0.001)]. Women with PPCM and anemia reported clinically significant history of obesity and smoking (p&lt;0.001). PPCM hospitalizations with anemia also had higher incidence of preeclampsia, AKI, acute pulmonary edema, and antepartum hemorrhage (Table). Conclusion: Our study demonstrates that anemia increases inpatient mortality rate in women with PPCM. Anemia also increases in-hospital incidence of preeclampsia, AKI, acute pulmonary edema, and antepartum hemorrhage in women with PPCM.